CommercialApril 1, 2021
Georgia Anthem preapproval list change notification 3/1/2021
AIM Specialty Health, a separate company, is a nationally recognized leader delivering specialty benefits management on behalf of Anthem for certain health plan members. Determine if preapproval is needed for a Georgia Anthem member by visiting the “Medical Policy and Clinical UM Guidelines” page on our provider website or by calling the preapproval phone number printed on the back of the member’s ID card. To submit your request for any of the services below, contact AIM online via AIM’s provider portal at aimspecialtyhealth.com/goweb. From the drop-down menu, select GA. You may also call AIM toll-free at 866-714-1103, Monday–Friday, 8:00 a.m.–6:00 p.m. ET
AIM provides benefits management for the programs listed below:
- Imaging level of care
- Genetic testing
- Diagnostic imaging management
- Cardiovascular services
- Radiation therapy services
- Outpatient sleep testing and therapy services
- Cancer care quality program
- Musculoskeletal (for fully insured)
- Upper gastrointestinal endoscopy
For more details on these programs, please visit the AIM Specialty Health® site at aimspecialtyhealth.com/marketing/guidelines/185/index.html. By clicking on the previous links, you will be directed to sites created and/or maintained by another, separate entity (“external site”). Upon linking you are subject to the terms of use, privacy, copyright and security policies of the external sites. We provide these links solely for your information and convenience. We encourage you to review the privacy practices of the external sites. The information contained on the external sites should not be interpreted as medical advice or treatment provided by us.
Eligibility and benefits
Eligibility and benefits can be verified by through anthem.com/provider or by calling the number on the back of the member’s identification card. Service preapproval is based on member’s benefit plan/eligibility at the time the service is reviewed/approved. Benefit plans vary widely and are subject to change based on the contract effective dates. The provider is responsible for verification of member eligibility and covered benefits. Except in the case of an emergency, failure to obtain preapproval prior to rendering the designated services listed below will result in denial of reimbursement.
Add to preapproval |
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GENE.00056 Gene expression profiling for bladder cancer |
0012M, 0013M, 0016M |
Added 7/1/2021 |
LAB.00038 Cell-free DNA testing to aid in the monitoring of kidney transplants for rejection |
0118U |
Added 7/1/2021 |
SURG.00159 Focal laser ablation for the treatment of prostate cancer |
0655T |
Added 7/1/2021 |
TRANS.00037 Uterine transplantation |
0664T-0670T |
Added 7/1/2021 |
Codes added to existing preapproval documents |
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CG-GENE-14 Gene mutation testing for solid tumor cancer susceptibility and management |
0229U, 81309, 0155U, 0177U; RAS 81275, 81276, 81311, 0111U; BRAF 81210 |
Added 4/1/2021. All moved from other MP/CGs. |
GENE.00049 Circulating tumor DNA panel testing for cancer (liquid biopsy) |
0242U |
Added 4/1/2021 |
LAB.00033 Protein biomarkers for the screening, detection and management of prostate cancer |
0228U |
Added 5/1/2021 |
SURG.00121 Transcatheter heart valve procedures |
0646T |
Added 7/1/2021 |
CG-GENE-13 GenetictTesting for inherited diseases |
81161, 0218U |
Added 5/1/2021 |
GENE.00052 Whole genome sequencing, whole exome sequencing, gene panels, and molecular profiling |
0244U |
Added 4/1/2021 |
LAB.00011 Analysis of proteomic patterns |
0247U |
Added 4/1/2021 |
CG-GENE-04 Molecular marker evaluation of thyroid nodules |
0245U |
Added 4/1/2021 |
PUBLICATIONS: April 2021 Anthem Provider News - Georgia
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